A Trend to Consumer-Driven Medicine




AS A CONSUMER of medical care in New Hampshire, you know that health care has undergone significant changes in the last decade. What you may not know is what sits on the horizon. In the near future, some forms of medicine might be practiced and marketed in the same way other high-end consumer products are with an exclusive, luxury angle and with at least some aspect of pampering added into the mix. Precursors to the trend are already here. The alternative health movement combines such pleasant modalities as reiki, massage and aromatherapy baths for a healing regimen that, while not scientifi- cally established as a cure for anything more than stress, is nonetheless a lot more enjoyable than a flu shot. Although, if needles are your thing, there is always acupuncture. The cosmetic surgery industry offers a variety of services that can be of enormous therapeutic benefit in cases of birth defect or physical trauma, but can also serve as a cafeteria of enhancements for the lives of completely healthy individuals. One consumer-driven trend that has found its way from trendy California to as close as stodgy old Boston is the full-body MRI. Some practitioners say that up to a third of their clients discover latent problems during these scans, problems ranging from degenerative disks to tumors, cardiac problems or arterial calcification. The ability to scrutinize one’s own future health profile will take another giant leap when genetic profiling becomes mainstream. Suddenly an individual will be able to assess his or her chances of contracting a textbook of different diseases. With Botox injections on demand, storefronts providing scans of any body part on a walk-in basis, and alternative therapies centers offering everything from chiropractic adjustments to “chakra cleansing,” there’s at least one thing you can count on: traditional medical insur- NHM-29-TopDoctors-04O4.QXD 3/5/04 6:14 PM Page 30 New Hampshire Magazine | APRIL 2004 3 1 ance probably won’t cover the procedures. One small but growing trend in medicine consists of a subsection of physicians — mostly general practitioners and internists — who are opting out of regular practice to focus on treating a small group of people who essentially put their doctor on retainer. That way they are guaranteed immediate access to health care and a maximum of personal, unhurried attention and time. Most often called “boutique medicine,” such practices are attracting both support and criticism. Here’s how it works: A patient registers with a doctor in order to stay with him as a patient. A registered patient can see the doctor almost any time he wants. Appointments will often be 30 to 45 minutes. The doctor (or his coverage) guarantees he will meet you at the hospital if you need to be admitted. The catch? There is an annual registration fee — from $1,500 to $12,000 a year. The fee isn’t covered by insurance nor applied to medical costs. Co-payments are made and insurance is billed as before. To achieve this level of service, physicians have to limit the number of patients they accept. For doctors who are slogging through the pressures and frustrations of running the standard full-time practice, fewer patients and less paperwork sounds ideal. Though boutique practices are springing up across the country, it’s apparently not happening here. Palmer Jones, executive vice president of the N.H. Medical Society, says, “I do not foresee this coming into New Hampshire.” New Hampshire median household income is among the highest in the nation, so there are plenty of patients who could easily afford the fees. “But we do not have the volume to support such practices,” he continues. “There are more patients in Connecticut than in all of northern New England combined. But in New Hampshire, it’s not likely to happen.” Maybe New Hampshire’s traditional frugality and egalitarianism contributes as well. Should we care that we’re being bypassed by this hot new trend? There is some controversy in the medical profession about the growth of boutique practices. Critics say that such practices further divide medicine into the “healthy wealthy” and the rest of the population, often removing the best physicians from more accessible practices. Last summer, the American Medical Association Council on Ethical and Judicial Affairs issued a position on the trend, saying boutique practices don’t violate medical ethics as long as they don’t promise better medical care. Would a patient who comes with cash in hand receive more, or faster, service? Jones admits this is possible, but he insists it is unlikely. “If a patient asks for an MRI, for example, that the doctor hasn’t recommended, I think the doctor would say ‘I’ve done a thorough clinical exam, and I don’t believe that an MRI is warranted.’ This would be the responsible approach.” Still, doctors who have pursued such a practice claim improved revenue flow and dramatically reduced patient loads. Some go from 2,000 patients down to 600 or less while the pricier plans state the maximum number of families per physician is a mere 50. MDVIP, a company based in Boca Raton, Fla., helps physicians all over the country convert their practices into retainer medical practices. Their Web site currently lists one Boston-based physician in their network, with undoubtedly more to come. Dr. Cynthia Cooper, president of the NH Board of Medicine, says consumerbased health care trends may be stymied by a sluggish economy, but notes that some areas of New Hampshire, like the Seacoast are certainly wealthy enough to embrace them. “I’ve already seen heart CAT scans advertised locally for detecting coronary artery disease,” she notes. “That’s an elective procedure. You pay in cash.” While such tests can catch diseases that might go undiagnosed, she explains that they also subject many people to unnecessary loads of radiation and can turn up problems that are not really significant but require further tests, ultimately costing the system even more money. And while it would be nice to go back to a time when everyone had a personal family physician, the eventual outcome for the move to personal doctors is to establish a separate health care system for the wealthy, agrees Dr. Cooper. So, for the time being, both doctors and patients in the Granite State are content to check out how boutique and à la carte medicine are playing out in states to the south. NH MARTHA BAUMAN AND LISA ROGAK CONTRIBUTED TO THIS STORY.
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